Replacing your joint with the help of a robotic arm
The original article can be found at The Star: https://www.thestar.com.my/lifestyle/health/2021/11/17/replacing-your-joint-with-the-help-of-a-robotic-arm
As our nation heads towards becoming an ageing one, we can expect to see an increase in people suffering from joint aches and pains.
The likely cause: wear and tear of the joints or osteoarthritis, where the cartilage within a joint begins to break down and the underlying bone begins to change.
While there is nothing much you can do to prevent it, there is no cause for alarm either.
“Everyone is going to get osteoarthritis at some point – it’s like your car tyres, they will wear out eventually to some degree,” says consultant orthopaedic surgeon Dr Lee Chong Meng.
“Most patients will end up having treatments such as medication, physical therapy or lifestyle modification.
“It’s only when those methods don’t work that we consider joint replacement surgery, but we will first assess the patient and discuss how much the arthritis is affecting their life.”
For a better life
Joint replacement means removing part or all of a damaged joint and putting in an artificial one – which can be made of plastic, metal, ceramic, or a combination of materials – to allow the limb to move without pain.
The joints that are usually replaced are the hip and knees.
More than a million such surgeries are carried out in the United States annually, making it one of the most common orthopaedic procedures performed today.
“Joint replacements are intended to relieve pain and improve quality of life, so that the grandma can run around to look after the grandkids or go on a holiday and walk without pain.
“With some old people, we are the last person they will consult as they will bear the pain for a long time, be in a wheelchair, etc, until nothing works – then they will seek help.
“With the younger group, they want to enjoy life and will consult us earlier,” says Dr Lee.
His youngest patient was 18 when she had both hips and knees replaced due to having juvenile rheumatoid arthritis since the age of four.
She was in a wheelchair, and being a teenager then, suffered a lot of psychosocial issues.
Dr Lee recalls: “I could have told her to go away and come back when she is 60, but I told the parents to consider joint replacement surgery. “However, they had to understand that she would need a revision surgery, maybe at 40 or 50 years old, as the artificial joints have a lifespan of 20 to 30 years. “They accepted it because their daughter’s condition was bad.”
Post-surgery, her quality of life improved – she started walking again, went to university, migrated and got married.
“Imagine, if we didn’t do this, her life would have been wasted.
“The downside is that she would need another operation.
“So there is really no fixed age for the surgery as it depends on the situation and stage of arthritis.
“But we prefer doing replacements in older people (65 and above), so that hopefully, this will be the only operation they will have in their lifetime,” he says.
If only part of the joint is damaged, then only partial joint replacement is necessary, as opposed to total joint replacement where the damage is severe.
People with bow legs are predisposed to osteoarthritis, but osteoarthritis also leads to bow legs, and total knee replacement surgeries will straighten the leg out.
“Patients tell me they are taller after both legs have been operated on,” Dr Lee says with a laugh.
Enter the robot
The majority of joint replacement surgeries in Malaysia are done by hand or via computer navigation, but technology is improving all the time.
While robotic technology is already being used in many medical disciplines, the use of the robotic arm in orthopaedics has only just recently been introduced here.
Basically, the robotic arm-assisted joint replacement surgery uses a CT (computed tomography) scan or X-ray data, along with robotic software, to generate a 3D virtual model of the joint to help the surgeon create a personalised pre-operative plan.
No, the robot does not function independently; instead, the surgeon guides the handheld robotic device within the predefined area.
This helps provide more accurate placement and alignment of the implant.
Says Dr Lee: “In the old days, we had to rely on our naked eyes to cut the bone and put the implant – if we cut it wrongly, the knee will be malaligned and it will wear out fast, just like car tyres. “And if the knee remains bent after surgery, then its function is affected. “So, there were many malaligned knees.”
Then came computer-navigated technology, which has superior results, but still has a plus-or-minus three degree margin of error. This is because it is the surgeon who inputs the information into the computer; if he misjudges, there is a chance of error. With the robotic arm, the error is less than one degree.
“This semi-active robot has an arm and is very clever. “Firstly, because the robot can see more than we can, it guides us to make a smaller incision. “Secondly, there is less soft tissue injury around the joint – a surgery itself is an injury and an insult to the body. “Being humans, we might cut more soft tissue than necessary, but the robot knows where to cut and when to stop, so if we go into the ‘hectic’ zone, it will automatically stop. “There is also less bleeding as it is highly accurate and precise,” says Dr Lee, who is among the first few doctors in the country to use this state-of-the-art technology for total/partial knee and total hip replacements.
Highly accurate
Two days prior to surgery, the surgeon and his team will discuss the case and procedure, after the robot has indicated the best placement of the implant for maximum function.
There are two types of joint replacement surgeries: cemented and uncemented.
In cemented surgeries, the surgeon will pour liquid cement on the natural bone to glue it to the implant and keep it in place.
It’s mostly suitable for older patients, whose bones may not grow, especially if they are osteoporotic.
“In younger patients who are more active, we use the uncemented type because the cement is not going to be able to withstand the demands placed on it.
“The uncemented surface is rough, and when we place the implant, the new bone grows into its spaces, holding it in place without the need for cement,” Dr Lee explains.
The finished “product” can be viewed even before surgery commences, so that doctors can adjust or tweak things.
“In the past, we would do the operation and second-guess ourselves by asking, ‘Did I cut the bone right?’.
“We only see the X-ray the next day, by which time it is too late for adjustments.
“Here, during the operation, the robot will execute the plan, and if we are a little bit off, the robot will stop – just like a teacher who will smack you if you’re wrong.
“There are so many checkpoints throughout the whole process that it’s hard to get things wrong.
“There are not many decisions to make during the operation,” he says.
Studies show that robotic surgeries result in better outcomes, compared to conventional joint replacement surgeries. These include shorter hospital stays, less post-operative pain, a more natural feeling of the limb, and a quicker return to normal activities.
Robotic surgery takes about 10 minutes longer than the one-hour conventional surgery.
Patients will spend one to four days in the hospital post-surgery, depending on the type of surgery and their recovery process. They should be able to resume most activities after six weeks. However, high-impact or contact sports are discouraged after surgery.
Says Dr Lee: “You can run across the road to save your life, but we don’t encourage running as an exercise because a high-impact activity will wear out the joint faster. “But some patients don’t listen and have climbed mountains and gone skiing three months after surgery.”
He explains: “The knee joint is an enclosed space, so when you apply a sudden brake, it can affect the bone and cause lesions, unlike your car brakes where the particles will fly out into the atmosphere when you brake.”
So, in order to preserve the replacement joint, it’s best to stick to activities such as doubles tennis, walking, swimming, golfing, light hiking and other low-impact sports.
Do some ‘shopping’
Before agreeing to a joint replacement surgery, Dr Lee encourages patients to shop around for doctors and opinions.
“If a surgeon tells you, you need an operation, go for a second or third opinion until you’re happy that it is the only option. “For a lot of patients who see me – I may be the fourth doctor they have consulted! “Then a patient might ask, why does one surgeon or hospital charge so much more than the other?
“It is important for patients to understand what type of implant is being put in as the cost will vary according to the material used.
“Every year, a new generation of implants with better resistance comes out, so the newer the model, the more expensive it is – and theoretically, it should last longer,” he says.
The robotic arm is not available in all hospitals as it costs a few million ringgit, hence only big hospitals can afford to buy it.
Dr Lee says: “Patients have to pay for the use of the robot and disposables, i.e. things that we feed into the robot that can only be used once. “A single total knee replacement costs around RM30,000 and using the robot will cost another RM2,000 to RM3,000 extra. “As a surgeon, I think it is worth it, but in the end, it is the patient who decides.”
Dislocated Shoulder – When is Surgery Required and Not Required?
by Dr Gandhi Nathan Solayar FRCS (Tr&Orth)
Key Takeaways:
In summary, not all patients require surgery following a shoulder dislocation
Most frequent causes of shoulder dislocations is a traumatic injury that may occur following falls, sports and motor vehicle accidents.
A dislocated shoulder is manipulated back into place by a trained doctor or orthopedic surgeon with the patient under sedation & pain medication
Proper rehabilitation is the key regardless of the treatment method chosen
Shoulder dislocations are one of the most common injuries affecting the shoulder joint. It occurs when the arm bone (head of the humerus) comes out of its socket (the glenoid). The annual incidence (frequency of occurrence) is thought to be between 20 and 40 cases for every 100,000 people (assuming a population of 32 million, that comes up to around 8000 to 10,000 cases in Malaysia each year). It is more common in males and the younger age group (between 16 and 21 years of age).
How Dislocated Shoulder Happens: Explanation from Orthopedic Specialist Dr Gandhi Nathan Solayar
The most frequent cause of shoulder dislocations is a traumatic injury that may occur following falls, sports and motor vehicle accidents. The shoulder normally dislocates anteriorly (towards the front), bringing injuries to specific structures in the joint. These may include a Bankart lesion (torn labrum), Hill-Sachs lesions (bony depressions of the humeral head) and fractures within the joint. Between 10 and 40% of shoulder dislocations may have an associated nerve injury (the axillary nerve is most often injured, and reassuringly, most of these injuries settle with time).
Bankart Lesion following shoulder dislocation (from www.shoulder-pain-explained.com)
Non-Invasive Treatment for Joint Dislocation
Once a dislocation occurs, the priority is for immediate relocation (returning the joint into its natural position). In the majority of cases, this is performed without the need for surgery. The patient is brought to a hospital, and the shoulder is manipulated back into place by a trained doctor or orthopedic surgeon with the patient under sedation & pain medication. After confirming proper relocation (using x-rays), the arm is normally immobilized using a sling.
When opting for non-surgical treatment, the patient is advised to continue using an arm sling for some weeks. This period of immobilization allows for soft tissues around the shoulder to heal. Following this, rehabilitation begins (physiotherapy) to restore the shoulder joint’s movement and strengthen the surrounding muscles. There are many factors that affect recovery time; among them include the patient’s age, co-morbidities and pre-injury functional level.
The concern among shoulder surgeons is the re-dislocation rate following injury. Factors that influence this include the patient’s age (higher risk in younger patients), gender (higher in males), fractures and Hill-Sachs lesions. Re-dislocations rates are higher in repeat dislocations (more than two episodes of dislocations involving the same joint). In these circumstances, non-surgical methods alone may not be sufficient. Further investigations (using CT and MRI scans) may also be required.
Hill-Sachs and Bankart Lesions (from https://flawlessmotion.com)
The ideal candidate for non-surgical treatment following a shoulder dislocation would be an elderly, sedentary, non-active individual with no associated injuries (fractures). In younger, active and high functioning individuals (these may include those involved in a sporting activity or work with their hands), timely surgical management is the ideal option.
Historically, shoulder stabilization surgery was performed by the open method. This required a fairly large incision and releasing large muscles around the shoulder joint. These open surgeries would have resulted in large scars, prolonged recovery periods and higher rates of joint stiffness. With the advent of recent technological advancements, these open procedures are rarely performed these days (In my hands, open surgery for shoulder stabilization is done only in revision cases or in situations where there are large fractures involving the glenoid socket).
Most shoulder stabilization surgery nowadays is performed using an arthroscopic technique. This is a minimally invasive procedure (normally involving three incisions; each less than a centimetre) which allows for good visualization of the shoulder joint and appropriate fixation, allowing for restoration of normal anatomy. Routine shoulder stabilization surgery normally takes around one hour to perform and is done under general anaesthesia. The end result is aesthetically pleasing, and patients recover from surgery at a faster rate. In some of my patients, these procedures are done as day-cases where the patient returns home the same day of surgery.
Bankart Repair (Shoulder stabilization). From https://hbgmedicalassistance.com
Patient Selection for Surgical Joint Dislocation Treatment
As with most cases, patient selection is an important factor when considering someone for arthroscopic shoulder stabilization. I would strongly advise anyone with more than two dislocations of the shoulder to undergo surgery (the chances of shoulder re-dislocation is very high in this group). In cases where the patient is young (below the age of 25) and highly functional (e.g., athlete), the re-dislocation rates are lower after surgical stabilization (compared to no surgery) and therefore advisable.
Another group of patients who would benefit from early surgical intervention would be those who suffer an associated fracture or rotator cuff tear (the rotator cuff tendons are a special group of muscles that play an important role in shoulder function). These injuries are more common in elderly patients with shoulder dislocations and, if not treated, may result in long term shoulder joint dysfunction. I often advocate for early surgical repair of these structures (if torn or damaged) as this improves overall recovery, and patients have a better chance of returning to pre-injury function.
Physiotherapy is Key in Dislocated Shoulder Treatment
In summary, not all patients require surgery following a shoulder dislocation. In my practice, I would treat low-demand, sedentary and elderly individuals using conservative methods without surgery. For those patients who are young, active, having significant fractures and who have suffered more than two dislocations, I would strongly advise surgical stabilization to allow for proper restoration of joint anatomy and return to function. Proper rehabilitation is the key regardless of the treatment method chosen.
In all, counselling and consultation with the treating orthopedic specialists would help determine the best treatment method for shoulder and joint dislocation. Contact us here for more info.
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
All You Need to Know About Elbow Dislocations
by Dr Gandhi Nathan Solayar FRCS (Tr&Orth)
Key Takeaways:
Elbow dislocations should be treated urgently as early reduction
Steps to immobilize the arm (such as a sling) would help with pain and application of ice or a cold compress may help reduce the swelling
Once an elbow dislocation has occurred, the most important step is to seek urgent medical help from an orthopaedic specialist as delay in treatment may worsen long term outcomes
The elbow is a joint which consists of three bones namely the humerus (upper arm) and two forearm bones (radius & ulna). It is an important structure and injury to this joint, if not properly treated, can be very debilitating to the patient in terms of arm function. In this article, we will look specifically at dislocations of the elbow joint in terms what, why, and how to appropriately manage this injury.
Image from www.versusarthritis.org
Common Causes & Symptoms of Elbow Dislocation
Elbow dislocations are fairly common injuries second only to shoulder dislocations in adults (in children, this is the commonest joint dislocation). It normally occurs after a fall with direct loading and rotation of the forearm. The elbow normally dislocates posteriorly (towards the back) and up to 50% of these injuries are associated with sporting activity.
X-ray showing a posteriorly dislocated elbow joint (from https://orthoinfo.aaos.org)
When an acute elbow dislocation occurs, the immediate symptoms include severe pain, deformity (large bulge at the back of the elbow due to the posterior olecranon dislocation), swelling and inability to move the joint. In some cases, there maybe associated fractures around the elbow joint. Severe cases may also demonstrate nerve and blood vessel damage which would need urgent treatment.
How to Manage Elbow Dislocation?
Once an elbow dislocation has occurred, the most important step is to seek urgent medical help from orthopaedic specialist as delay in treatment may worsen long term outcomes. At the point of injury, steps to immobilize the arm (such as a sling) would help with pain and application of ice or a cold compress may help reduce the swelling. The patient should be brought to the emergency department as soon as possible.
At the emergency department, a close examination of the limb is performed to rule out potential nerve and blood vessel injuries. The patient is made comfortable with pain killers and x-rays are taken to assess for associated fractures and the extent of the dislocation.
Reduction Technique – Treatment for Joint
Early reduction (restoring the bones back to its original position within the joint) is frequently performed after preliminary investigations. In the emergency room, this is done by initially sedating the patient and carefully manipulating the elbow joint back into place.
In certain cases, the orthopaedic surgeon may choose to perform the reduction under full anaesthesia (in the operating room) with the help of muscle relaxants and portable x-rays. Once the joint is reduced, the surgeon would often immobilize the elbow with plaster, fiberglass or a brace with the arm in an L-shaped position (Above elbow casting).
The elbow joint following reduction to its normal position (https://orthoinfo.aaos.org)
In some cases which involve fractures around the elbow joint, further imaging studies would be necessary. This would allow the surgeon to appropriately plan for surgical reconstruction of the elbow joint by proper fixation of the fractured fragments.
In my practice, this would include computed tomography (CT) scans to accurately assess the joint and extent of the injury. Once the fractures have been surgically stabilized and the elbow joint reduced, the arm is placed in a cast/brace similar to a non-surgically treated elbow dislocation.
Complex elbow fracture dislocation before and after surgery (from Cho et al. Diagnostics 2020)
In rare & severe cases involving arterial injury, immediate joint reduction is paramount. While reduction of the elbow often leads to a restoration of blood supply to the arm, further imaging studies (such as CTs or MRIs) maybe indicated to accurately confirm restoration of arterial function.
If the limb remains avascular (no return of blood supply), urgent surgery is required to save the limb with both the orthopaedic and vascular surgeon at hand to repair the injured artery and to stabilize the upper limb. Failure to do this promptly may lead to ischaemia, necrosis and possible limb amputation as a last resort.
Key Element of Dislocated Elbow Treatment
One key element in managing elbow dislocations following reduction is the balance between immobilization to allow for tissue healing and rehabilitation (movement of the elbow) for return to function. In most of my patients with elbow dislocations (either surgically or non-surgically treated), I would recommend a short period of immobilization (1-2 weeks in most cases) followed by careful, supervised rehabilitation concentrating on elbow movement.
I generally prefer my patients to use functional elbow braces as this protects the elbow joint while allowing for gradual increases in range of motion. Long term immobilization (more than 4 weeks) of the elbow joint is often associated with significant stiffness and therefore, should be avoided if at all possible.
Other complications (apart from joint stiffness) include locking, pain and reduction in achieving full elbow extension. This is occasionally seen in cases where fragments of bone or cartilage tears which occur during the initial injury become loose bodies within the elbow joint causing symptoms.
If left untreated, this may further lead to joint degeneration and worsening arthritis. These loose bodies can be successfully treated by minimally invasive techniques such as elbow arthroscopy which allow the surgeon to remove the offending matter, examine the joint and stabilize the remaining cartilage.
Joint Dislocation: Insight from Orthopaedic Specialist
In certain patients (particularly adolescents and young adults), a previous elbow dislocation can result in significant ligamental injuries around the joint which may contribute to pain, looseness and further dislocations; especially in those who participate in sporting activities which involve throwing.
In these patients, an MRI is often required to assess for the extent of damage to joint and surrounding ligaments. While this is not commonly performed, in cases of significant instability, surgical reconstruction of the ligaments around the elbow joint would allow for better resolution of symptoms and return to function. Proper, supervised rehabilitation is very important post-surgery particularly in this sub-set of patients in my view in achieving a good outcome. Contact us for more info!
In conclusion, elbow dislocations should be treated urgently as early reduction of the joint allows for timely immobilization, quicker rehabilitation and may prevent long term complications such as joint stiffness and loss of function. Associated fractures need to be accurately identified early (with the help of advanced imaging such as CT scans) and if surgery is required, early operative stabilization will allow for early rehabilitation. Adherence to supervised rehabilitation after the injury is paramount in achieving a good outcome in the treatment of elbow dislocations. Good luck!
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Can an ACL Tear Heal on Its Own? Here is an Explanation from OSC Bone Specialist
by Dr Gandhi Nathan Solayar FRCS (Tr&Orth)
Key Takeaways:
The short answer is NO (in the vast majority of cases)
ACL injuries are common, especially among those active in sports that involve pivoting and jumping (e.g., football, basketball, rugby, etc.).
The anterior cruciate ligament (ACL) plays a crucial role in maintaining the stability of the knee joint.
Can ACL Tear Really Heal by Its Own Without the Need of Surgery?
Over 800,000 ACL surgeries are performed by bone specialist doctors worldwide every year, and there is much interest in identifying the optimal way of treating patients with ACL injuries. The question here is: Can an ACL tear heal well without the need for surgery? In my view, the short answer is NO (in the vast majority of cases).
The Understanding of Torn Ligaments from Orthopedic Specialist
To understand the reason, we need to have a basic understanding of how torn ligaments heal. While the physiology of tissue recovery is complex, the basic chronology is as follows:
(1) a blood clot forms after initial bleeding;
(2) Inflammation occurs;
(3) new blood vessels form, which bring with it nutrients, new cells and oxygen required for healing;
(4) Fibrosis (scar tissue formation) occurs between the torn ends of the ligament;
(5) Over time, there is remodeling of the initial scar tissue into a structure similar to the ligament allowing it to resume its function – providing a stable connection between two bones.
When managing a ligament tear without surgery, it is vital that the limb is protected during the early phase – immobilizing it with a plaster cast or brace, for example – to prevent excessive movement, which would hinder proper recovery.
Good apposition (having both torn ends of the ligament close to each other) is also necessary during the crucial healing stage. Lack of proper apposition may result in elongation of the healed structure, thus negating its function as a restraining ligament.
What’s The Impact of ACL Tear?
In an ACL tear, however, there are a few factors that negatively impact the body’s innate ability for optimal recovery. In most cases, the ligament generally tears at its mid-point, which is mostly avascular – without a proper blood supply required for proper healing. The presence of joint fluid within the knee, which is vital for normal lubrication allowing movement, negatively affects the body’s capability of forming the ideal haematoma (blood clot).
A) Arthroscopic picture showing a torn ACL
B) The same patient showing the reconstructed ACL in the anatomical position
Immobilizing the knee for long periods to treat an ACL tear without surgery (often for six weeks or more) in itself may cause other problems. With limited movement, the knee capsule tends to scar and stiffen, resulting in reduced movement – arthrofibrosis. Without adequate movement and use, the muscles around the knee – quadriceps, hamstrings, calf muscles – waste away, resulting in weakness and complicates the recovery.
Furthermore, most patients are also required to non-weight bear, i.e. avoid walking on the affected leg when in a cast. It slows overall recovery as proprioceptive feedback is curtailed. Proprioception is an essential concept in rehabilitation which, in basic terms, the body knows where the limb is in space. The lack of this crucial neuromuscular feedback impedes the patients’ normal walking (gait) pattern and may prolong their ability to return to their normal function.
The torn ACL ligament remnant left untreated can lead to other problems. The remnant stump (we sports surgeons and bone specialists refer to this as the “cyclops lesion”) may cause clicking and pain within the knee joint. In severe cases, even a locking phenomenon (meaning the inability of fully straightening the knee; my patients sometimes refer to this as the knee “jamming”). In the longer term, this results in worsening stiffness and loss of entire knee joint function.
C) Presence of a large “Cyclops” lesion in the knee joint
B) After removing the cyclops and reconstruction of the ACL
Apart from the ACL tear, it is common to have associated injuries to other components within the knee, namely the meniscus and cartilage. The meniscus is a vital structure that provides stability and ensures proper distribution of load-bearing within the knee joint (in laymen terms, it provides “suspension” to the knee). Damage to this structure is associated with early degeneration of the knee joint and as such, proper restoration of meniscal function is key in treating patients with these injuries. Unfortunately, with an ACL tear, the added instability results in shear forces which make meniscal healing difficult despite proper surgical repair and rehabilitation. In my practice, I am aggressive with meniscus injuries, and I believe that early restoration of this structure together with a stable knee (ACL reconstruction) significantly improves outcomes in my patients overall in terms of rehabilitation and return to function.
Understanding what happens biologically to a torn ACL, we turn our attention to management options available to us as orthopedic specialists and surgeons. Not all torn ACLs require surgery, and in my practice, patient selection is crucial to ensure the right person receives the appropriate treatment.
Non-Invasive Treatment for Torn Ligament: An Orthopedic Perspective
Another focus of evolving strategies in dealing with ACL injuries without surgery is the use of biologics – stem cell therapy, in particular. This subject has received a lot of headlines in recent years, and many patients often ask my opinion regarding this option. I share the view taken by many sports surgeons worldwide in that the evidence supporting its use is still insufficient to justify the costs involved.
There is a tendency towards an industry-driven bias in the current literature, while some impartial observers do not report significant differences with patients treated with these. While there may be a role of augmenting ACL reconstructive surgery with the use of biologics, I am keen on seeing what the future holds in this field, particularly in orthopedics. One, in particular, is the future role of exosomes which are stem cell signaling molecules. These may mimic the role of biologics with lower costs. However, research in this area is still ongoing.
There are certain exceptions where I would consider non-surgical treatment in dealing with an active patient following an ACL rupture. In some cases where there is only a partial tear (confirmed on an MRI scan) without any related injuries to the knee joint, I believe functional rehabilitation alone is the ideal solution.
Close follow-up of their recovery with the help of physiotherapy is important in ensuring a successful outcome. The patient should be counselled on the possibility of delayed surgery if conservative management fails.
ACL Tear Injuries in Children and Teenagers
Another crucial area where non-surgical methods may be preferable is in cases of ACL injuries in children and adolescents. In the pediatrics ACL injury, we commonly see avulsions (where the bone is fractured or pulled off from its footprint) instead of mid-ligament tears, which are frequent in adults. In special circumstances, children can be treated in casts/braces alone with close follow-up by the orthopedic specialist.
The presence of a growth plate (in young, growing bones) presents its own set of unique challenges to the surgeon when dealing with injuries around the knee joint. In my hands, if surgery is required, I tend to perform minimally invasive repairs in children, as opposed to graft replacements in adults, or a modified reconstruction that minimizes injury to the growth plate in young adolescents.
Verdict from Bone Specialist Doctor on ACL Tear Treatment
In my view, the decision on how to manage ACL tears cannot simply be grouped into either surgical or non-surgical methods. The overall decision must be based on the individuality of every patient that presents to me with this injury. A careful history focusing on the patients’ needs, demands, and expectations are crucial in deciding on an appropriate management strategy. Similarly, the MRI scan will also help identify other critical structures that may be damaged (meniscus, cartilage, other ligaments etc.)
A personalized treatment plan is my method of choice as a sports surgeon and a bone specialist doctor. Among my mostly sedentary, elderly, low-demand patients and with comorbidities (other significant medical problems), I would mainly opt for a non-surgical approach. Conversely, in a young active individual, high demand activities (sports) and with injuries to other structures (commonly the meniscus), I would strongly advise for ACL reconstructive surgery. In my practice (especially in my cohort of elite, high-level athletes), I would perform surgery early. I believe this accelerates the patient’s recovery by minimizing muscle loss and reducing the “down-time” in terms of the period away from sports and an overall happier patient.
Proper Rehab with Physiotherapy For Torn ACL
There have been studies evaluating the role of rehabilitation alone without surgery in dealing with patients following ACL tears. Some researchers suggest that rehabilitation and physiotherapy without surgery may give rise to similar outcomes compared to patients undergoing early or delayed ACL reconstruction in terms of patient outcomes and overall function. Conversely, there is a large body of data that suggest otherwise, with the return-to-sports and favorable patient-reported results following ACL reconstructive surgery. How do we make sense of this?
Regardless of the options, properly supervised rehabilitation and physiotherapy treatment should be performed, emphasizing gradual movement recovery, muscular strength, and a return to function. Good communication between the bone specialist doctor and the physiotherapist is essential in the recovery period, especially in avoiding re-injury, monitoring progress and determining the appropriate time of return to high-level activity (in cases of athletes).
Consult with Orthopedic Specialist Centre (OSC) For Better Understanding
In summary, an ACL tear does NOT heal optimally on its own due to the reasons mentioned above. However, this does not necessarily mean that all cases of ACL tears require surgery and that an individual approach to each case is vital in deciding which patients would benefit from ACL reconstructive surgery. That being said, ACL surgery is a good option for most patients with a high likelihood of returning to pre-injury levels of function. Proper counselling of one’s options with the treating orthopedic specialist would help determine the ideal method of managing this common injury. Good luck! Contact us here for more info.
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Topic: Overview of Shoulder Instability
Part 2 of the shoulder webinar will update on surgical treatment for structural instability and conservative treatment for functional instability. For acute and postoperative management, the new principle of “POLICE” (progressive optimal loading) has moved past the traditional RICE to speed up recovery, enable early return to ADL.
The shoulder has got more mobility and the fastest movement than any other joints in the body. As the shoulder doesn’t have much bony stability, a lot of the stability and movement of the shoulder depends on muscle function. The importance of proprioception, neuromuscular training and posture control for shoulder rehabilitation exercises are well recognized, yet not much practiced. Recent research shows these can be improved by modality assisted exercises in the clinic and at home.
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Orthopaedic Specialist Centre (OSC) has been successfully appointed to the panel of 3 TPAs: Integrated Health Plans (IHP), Healthmetrics and EMAS.
Key Takeaways:
More patients can now gain access to OSC’s doctors and facilities.
For any bookings or enquiries, please call +603 8084 3636 or WhatsApp us +60 16-938 7830
List of Panel TPAs
Healthmetrics Sdn Bhd
Integrated Health Plans (Malaysia) Sdn Bhd
Eximius Medical Administration Solutions Sdn Bhd (EMAS)
List Of Panel Insurance
Ammetlife
Archipelago Insurance Limited
FWD medical underwriting
Gibraltar BSN
Hong Leong Assurance Berhad (staff)
Hong Leong MSIG Takaful
Lonpac Insurance
MPI Generali
MPR Generali Insurance Berhad
Pacific Insurance
Public Mutual
Tokio Marine Life Malaysia
Zurich Staff and Corporate Staff
Zurich Insurance (General and General Takaful)
Corporations that are on the TPA panels available at OSC
Dr Lee Chong Meng, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC) talks about the use of navigation for total knee arthroplasty (TKA) improves limb alignment in the coronal and sagittal planes.
Dato’ Dr Lim Boon Ping talks about his philosophy when treating his patients, his vision for OSC, and what patients can look forward to when visiting OSC.
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Dr Tai Cheh Chin talks about his philosophy when treating his patients, his vision for OSC, and what patients can look forward to when visiting OSC.
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Dr Lee Chong Meng talks about his philosophy when treating his patients, his vision for OSC, and what patients can look forward to when visiting OSC.
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Mr Tan enlisted the help of Dr. Lee Chong Meng and the staff at OSC Orthopaedic Specialist Centre for a bilateral-knee replacement. Notice the difference in how he walks pre- and post-surgery! Watch the video below
Key Takeaways:
Patients are normally able to start walking the next day after surgery
OSC uses computer aided navigation surgery to ensure highly accurate and successful surgery for all our patients
By undergoing surgery, a patient’s quality of life can be greatly improved
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Madam Liow has been having chronic left knee pain and she requires a walking aid to ambulate herself. Using computer assisted navigation surgery at OSC, you can see the difference in Madam Liow’s quality of life between pre- and post-surgery. Watch the video below
Key Takeaways:
Patients are normally able to start walking the next day after surgery
OSC uses computer aided navigation surgery to ensure highly accurate and successful surgery for all our patients
By undergoing surgery, a patient’s quality of life can be greatly improved
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Dr Tai Cheh Chin, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC), explains why joint replacement surgery is a good option for patients with advanced osteoarthritis of the knee
Key Takeaways:
Prevalence of OA in those aged 65 or older is between 50-60%
There are 3 surgical procedures that can be done: Arthroscopy, Osteotomy and Knee Replacement Surgery
The patient should be back to normal after six weeks, and can return to physical activities after three months
Joint replacement can also be done for the ankle, shoulder, elbow, spine, finger and toe
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Dr Gandhi Nathan Solayar, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre(OSC) educates the importance of having good mobility alongside good bone, muscle and joint health. Watch the video below
Key Takeaways:
Immobility (People who are sedentary) have a higher risk of osteoporosis
Active lifestyle and good mobility reduces plays an important role in reducing risk of having Osteoporosis
You can identify and diagnose Osteoporosis by doing a Bone Densitometer Scan
Risk factors of Osteoporosis: Age, Gender, Family History, Lifestyle and Diet
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Dr Tai Cheh Chin, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC) says “What we really want, if possible, is not to have any intervention at all. So, medicine is moving more and more towards (non-intervention) and prevention.”
Dr Gandhi Nathan Solayar, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre(OSC) , talks about Pressure Ulcers. Watch the video below
Key Takeaways:
Ulcers occur commonly over elbows, back, hips, buttocks and heels
People at risk: Elderly, disabled people, bed-bound or wheelchair bound, fragile skin, being unable to move or walk without help
Complications: Pain, Skin breakdown, Skin infection, Bacteria in the bloodstream, Bone/Joint injection, Cancer or Death
Ways to prevent: Repositioning, Use Cushioning/Supportive Surfaces
About OSC:
Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my
Dr Tai Cheh Chin, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC) explains that it is important for a surgeon to be able to get the patient to stand and walk within the shortest period of time, and minimize the pain to raise his or her confidence after surgery.
Key Takeaways:
Chronic arthritis is prevalent among the elderly population
It is important for a surgeon to be able to get the patient to stand and walk within the shortest period of time, and minimize the pain to raise his/her confidence after surgery
Get your doctor to assess your condition and review your options
Purpose of surgery: To help patients eliminate joint pain, stabilize the joint, improve joint function and correct deformity
Dr Tai Cheh Chin, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC) says “Hyaluronic acid injection is effective in relieving pain and eliminating swelling. It needs no operation, causing no bleeding and little pain. It helps the knee joint regain the normal ability to walk and it is the best choice of treatment apart from surgery.”
Key Takeaways:
One of the most common forms of arthritis is osteoarthritis (OA), normally occuring at knee, elbow, and other joints
Injection at the knee alleviates pain for mild to moderate OA
After injection of Hyaluronic Acid, OA patients’ joints have new supply of lubricant and their function is restored
Hyaluronic Acid is a local treatment, therefore it has little or no systemic side-effects
Among Dr Tai’s 1500 patients who have received knee injection, about 70% of them had their pain completely relieved
Dr Tai Cheh Chin, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC) talks about preventative measures to save you from Osteoarthritis(OA)
Key Takeaways:
Patients with Osteoarthritis should modify their lifestyles, maintain right posture and perform regular exercise
When in pain, rest more. When not in pain, exercise more
Dr Tai Cheh Chin, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC) talks about how Joint Replacement Surgery enables the patient to move away from pain, enjoying a new lease of life.
Key Takeaways:
An osteoarthritis patient can get up from the wheelchair and more freely, regaining a new life
Joint replacement surgery has the highest success rate among all joint surgeries
Surgery will stabilize the join and correct deformity
Patients are able to walk independently 4 to 6 weeks after surgery
Dr Tai Cheh Chin, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC) shares patients can reduce pain of osteoarthritis through changes of lifestyle, body weight control, drug and diet treatment and more.
Key Takeaways:
A patient can reduce pain through changes of lifestyle, body weight control, drug and diet treatments
Osteoarthritis can “attack” any joint of the human body including joints in the knee, hip, spine and ankle
Doctors can diagnose Osteoarthritis by examining the X-ray of affected joints and understanding the medical history and symptoms of the patient
Dr Tai Cheh Chin, Consultant Orthopaedic Surgeon at Orthopaedic Specialist Centre (OSC) shares tips to managing moderate-to-severe osteoarthritis (OA) pain
